Massive rhabdomyolysis and multiple organ dysfunction syndrome caused by leptospirosis
Massive rhabdomyolysis and multiple organ dysfunction syndrome caused by leptospirosis
复制标题
DOI：
10.1007/s001340051252
复制
发表时间：
2000-06-01
影响因子：
38.9
通讯作者：
Maki, DG
中科院分区：
文献类型：
--
作者：
Coursin, DB;Updike, SJ;Maki, DG
我们报告了一名 63 岁男子感染钩端螺旋体的病例，他在夏威夷的运河和溪流中游泳时感染。该患者的病程不典型，表现为发烧、快速进展且严重的横纹肌溶解、血小板减少、急性肾功能衰竭和呼吸窘迫综合征时，无黄疸且没有脑膜炎的证据。尽管他在长期患病后康复了，但他需要主要的生命支持，包括机械通气和血液透析。最初的抗菌治疗旨在覆盖主要细菌和非典型病原体，包括钩端螺旋体。对造成这种灾难性疾病的原因进行的深入检查证实是急性钩端螺旋体病。虽然很少见，但钩端螺旋体病是一种潜在致命的感染，通常与肝炎、氮质血症和脑膜炎相关。大多数患者会出现自限性疾病，包括发烧、肌痛和不适，随后出现免疫介导的无菌性脑膜炎。一小部分人出现休克和多器官功能障碍。虽然肌痛在钩端螺旋体感染中普遍存在，并且大多数患者表现出肌酶轻度升高，但危及生命的横纹肌溶解症很少见。据报道，这一非典型病例敦促临床医生在评估患有隐源性败血症的患者时考虑钩端螺旋体病，该患者出现与横纹肌溶解相关的多器官功能障碍，使用青霉素或多西环素进行适当的抗菌治疗可以挽救生命。
We report a case of leptospiral infection in a 63-year-old man who acquired the infection while swimming in canals and streams in Hawaii. The patient's course was atypical in that he was anicteric and had no evidence of meningitis when he presented with fever, rapidly progressive and severe rhabdomyolysis, thrombocytopenia, acute renal failure, and respiratory distress syndrome. Although he recovered after a protracted illness, he required major life support, including mechanical ventilation and hemodialysis. Initial antimicrobial therapy was designed to cover major bacterial and atypical pathogens, including leptospires. An in-depth work-up for causes of this catastrophic illness confirmed acute leptospirosis. Although rare, leptospirosis is a potentially lethal infection classically associated with hepatitis, azotemia, and meningitis. Most patients experience self-limited illness, with fever, myalgias, and malaise followed by an immune-mediated aseptic meningitis. A small proportion develop shock and multiple organ dysfunction. Whereas myalgias are ubiquitous in leptospiral infection, and most patients show mildly elevated muscle enzymes, life-threatening rhabdomyolysis is rare. This atypical case is reported to urge clinicians to consider leptospirosis in the evaluation of a patient with cryptogenic sepsis who develops multiple organ dysfunction associated with rhabdomyolysis, Appropriate antimicrobial therapy, with penicillin or doxycycline, can be life-saving.